Article Figures & Data
Figures
- Fig 1.
Case 15. A type I DAVF in a 46-year-old woman with left conjunctival erythema. Submentovertex (A–D) and sagittal (E–H) corresponding MIPs of consecutive whole-head volumes with an effective frame rate of 2 s. Frame A is arbitrarily taken as time zero. I, DSA lateral view of injection into the left internal carotid artery. Rapid arterial phase filling of the left superior (arrows) and inferior (arrowheads) ophthalmic vein as well as filling of the left angular vein of the face (curved arrows) is seen because of a left carotid-cavernous fistula. There is no evidence of CVR. Note the faint amount of signal intensity overlying the superior sagittal and sigmoid sinuses on F (open arrows). This is artifactual signal intensity because of the modified k-space collection scheme of the TRICKS technique (ie, the sharing of peripheral k-space data, some of which is collected well into the venous phase), which results in a small amount of normal venous “contamination” in the final images. This contamination is easily differentiated from pathologic early venous filling because it is not evident in the earlier frames (A and E), nor does it match the intensity of the arteries or the truly abnormal early venous filling (until later frames coincident with normal venous filling as in H).
- Fig 2.
Case 31. A type II DAVF in a 71-year-old man with a progressive neurologic deficit. Submentovertex (A–C), sagittal (D–F), and anteroposterior (G; frame as C and F) MIPs of whole-head trMRA volumes. H, DSA lateral view of an injection into the left common carotid artery. A DAVF located at the torcula with early arterial phase filling of the superior sagittal sinus (arrowheads), straight sinus (open arrow), and vein of Galen as well as rapid filling of multiple tortuous superficial cortical veins over both cerebral convexities (arrows). Note the differential rate of filling of the superior sagittal sinus and refluxing cortical veins vs the later normal venous phase filling of the left sigmoid sinus (dashed arrow), which fills via the brain.
- Fig 3.
Case 5. A type III DAVF in a 60-year-old man presenting with an intracranial hemorrhage. A–D, trMRA sagittal MIPs (2-s frame rate) and (E) DSA lateral view from an injection into the left internal carotid artery. There is a DAVF located over the left aspect of the cribriform plate with rapid early arterial phase filling of a subarachnoid venous pouch (arrow), which drains via an abnormal leptomeningeal vein (open arrow) to the superior sagittal sinus (arrowheads).
- Fig 4.
Case 23, a patient with treated DAVF with residual Borden type I shunt. Anteroposterior (A–E) and submentovertex (F–J) MIPs of consecutive whole-head volumes with an effective frame rate of 2 s. K and L are DSA anteroposterior and lateral views of an injection into the left external carotid artery. A persistent DAVF is located at the left sigmoid sinus, with residual shunt into the left transverse sinus and across the torcula to the right transverse sinus and down the right jugular vein (arrows). The left jugular vein is occluded. Endovascular coils from previous treatment can be seen overlying the left transverse sinus (open arrow) on DSA. Note the normal (later) filling of the superior sagittal sinus at 6 s in Figs D and I (curved arrow). In this case, reader 1 incorrectly suspected CVR.
- Fig 5.
Case 13. A type I, low-flow, residual carotid-cavernous fistula in a 55-year-old man after previous embolization. This represents a false-negative result in which one of the readers did not correctly identify the presence of a fistula. Submentovertex (A–C) and anteroposterior (D) MIPs of trMRA whole-head volumes. DSA (E) frontal and lateral (F) views of a left internal carotid injection. A small amount of early filling of the left cavernous sinus (arrow) with truncated outflow to the superior ophthalmic vein (open arrow) is seen on both modalities.
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